Provider Demographics
NPI:1083945943
Name:AGRONT, WANDA ENID
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:ENID
Last Name:AGRONT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 33193
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9766
Mailing Address - Country:US
Mailing Address - Phone:787-629-2390
Mailing Address - Fax:787-882-1535
Practice Address - Street 1:CARR 107 # KM 3/5
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5970
Practice Address - Country:US
Practice Address - Phone:787-891-5479
Practice Address - Fax:787-882-1535
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7729183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician